# SOUTH EAST LIVINGSTON COUNTY AMBULANCE SERVICE, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SELCAS Ambulance
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407856974
- **Authorized official:** JEREMY STOLLER (PROCUREMENT OFFICER)
- **Authorized official phone:** (815) 692-3658

## Contact information

- **Practice address:** 310 W LOCUST ST, FAIRBURY, IL 61739-1068
- **Practice address phone:** (815) 692-3452
- **Practice address fax:** (815) 692-2414
- **Mailing address:** 310 W LOCUST ST, FAIRBURY, IL 61739-1068
- **Mailing address phone:** (815) 692-3452
- **Mailing address fax:** (815) 692-2414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 26721 | IL | Yes |

## Other

- **Enumeration date:** 07/27/2005
- **Last updated:** 02/11/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5390005 | BCBS OF IL PROVIDER \# | IL |
| 01 | — | 590011250 | RAILROAD MEDICARE | IL |